Identity Resolution Daily

By the Infoglide Team

OCDQ Blog: The Data-Decision Symphony

“Data is now everywhere.  Data is no longer just in the structured rows of our relational databases and spreadsheets.  Data is also in the unstructured streams of our Facebook and Twitter status updates, as well as our blog posts, our photos, and our videos. The challenge is can we somehow manage to listen for business insights among the endless cacophony of chaotic data volumes, and use those insights to enable better business decisions and deliver optimal business performance.”

SecurityInfoWatch.com: Welcome to the melting pot

“A Fusion Center is a terrorism prevention and response center program that began as a joint project between the DHS and the U.S. Department of Justice’s Office of Justice Program. It is designed to gather information from government and the private sectors to aid in safety and security. The Fusion Centers share information at the federal level between the CIA, FBI, DoJ, U.S. Military and state and local level governments, as well as Emergency Operations Centers in the event of a disaster. State and local police departments provide both space and resources for the majority of Fusion Centers. The analysts working there can be drawn from DHS, local police, or the private sector as in the case of Dallas.”

South Florida Business Journal: Clinic operator convicted in $2.3M fraud

“According to evidence presented during the two-week trial in Michigan, between about November 2006 and March 2007, the defendants submitted about $2.3 million in claims to Medicare for injection therapy services that were never provided and were not medically necessary. Medicare paid about $1.7 million.”

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By the Infoglide Team

Fraud Prevention: Medicare and Medicaid Fraud: US Healthcare Reform

“Earlier this year, a jury found Pfizer owed Wisconsin $9 million for violating the state Medicaid fraud law more than 1.4 million times by purposely overcharging the state for prescription drugs. The company faces potential fines from $140 million to $21 billion.”

Security Debrief: What is a Law Enforcement Fusion Center?

“Fusion centers that are doing strategic analysis are best positioned to prevent criminal acts. Trained intelligence analysts in these centers look at a local tip or Suspicious Activity Report (SAR) and then use advanced search tools across many databases simultaneously for indications that the tip could be part of a much bigger ‘iceberg’ hiding below the surface.”

ZDNet: Yankee Group: Infrastructure as a Service now a bona fide cloud strategy

“The survey of 400 enterprises finds ‘24 percent of large enterprises with cloud experience’ are already using IaaS, and an additional 37 percent expect to adopt IaaS during the next 24 months. ‘While adoption is still much slower than that of SaaS solutions, the market is gaining traction,’ says Yankee.”

Detroit Free Press: Tiny name differences on tickets not a worry

“Under its new ‘Secure Flight‘ process, the government compares airline passenger names, gender and birth dates with data on a terror watch list. However, a reservation or boarding pass that uses a middle initial instead of a full middle name, misses a hyphen, contains a tiny typo or leaves off the ‘Jr.’ designation should not cause a problem, according to the Transportation Security Administration.”

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[Post from Infoglide] The Not So Great Fortune 500 Enterprise

“Of the various types of crime involving fraud, individual cases of people scamming workers’ compensation garner the most publicity. The stories typically read like this: ‘Joe Blow was drawing workers’ comp while working as a personal trainer, and after he was caught on video, he had to pay back $9000 and received a five-year suspended jail sentence.’ While the human interest aspect of these stories, especially those including video of an injured worker involved in heavy physical activity, capture the most public attention, more organized activities impact the U.S. economy much more negatively.”

Cato Unbound: The Sky Isn’t Falling

“But a careful observer can detect the outlines of other intelligence successes based on surveillance in recent events. When David Headley was arrested for allegedly seeking to commit terrorist acts in Denmark, news reports suggested that one of the key factors in his identification was his pattern of travel to the Middle East and his efforts to conceal those trips from the government. Review of his travel both provided the trigger to ask questions and the factual cross-check on the veracity of his answers. Likewise, when Najibullah al-Zasi was arrested, one factor that was publicly disclosed as a ground for suspicion was surveillance of his travel to Pakistan.”

CIO: Healthcare Data Quality: Providing Better Patient Care

“Three things immediately jump to mind. The first is something very basic, but important: being able to identify a patient. Think of how many different ways might a patient’s name appear in a physician’s database. From misspellings to inconsistent middle name initial usage, multiple combinations of a name can lead to confusion. If healthcare providers don’t know who their patients are, how can they provide them with quality service?”

GovMonitor: Washington Cracks Down On Workers Compensation Fraud

“‘For every dollar Labor and Industries spends to combat fraud, we’ve seen an eight dollar return,’ Gregoire said. ‘By preventing and punishing fraud, we protect workers and honest businesses from unfair competition. Fraud in the workers’ compensation system hurts our economy – honest businesses are undercut by those that don’t fairly participate in the system and workers pay more than they should when others claim more benefits than they deserve.’”

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[Post from Infoglide] Reference Linking Methods - Part 3

“This is the third in a series of four posts that discuss four methods for linking references.  These methods are:

1. Direct matching
2. Transitive linking
3. Linking by association
4. Asserted Linking

In the last post I discussed transitive linking, and why it is essential for producing a unique and deterministic outcome of an ER process.  In this post I will discuss the third method, linking by association.”

BeyeNETWORK: Computed Attributes, Entity Resolution and Connectivity Hierarchies

“There are many types of relationships that are discovered as a by-product of entity resolution, such as households or families. These terms take on different meaning depending on the subject area and the business situation. For example, we can examine parent-child and sibling relationships associated with individuals, we can look at components such as paper clips or screws that are in the same ‘family,’ or we can look at corporate ownership relationships that reflect families of companies. Alternatively, we can look at other types of relationships – individuals belonging to the same health club, components manufactured from the same type of metal, or companies that share the same board members.”

WTVM: Phenix City doctor accused of multi-million dollar Medicare fraud

“In an 80-page  civil complaint, the United States Attorney’s Office claims 51-year-old Doctor Robert Ritchea, a physician, not only allowed an unlicensed medical assistant to inject patients with pain medications, but also improperly billed Medicare for the treatments. The complaint also alleges Ritchea over-billed Medicare by more than $2.2 million in over 4,300 separate claims over a period of four years.”

Liliendahl on Data Quality: Location, Location, Location

“If you know that 123 Main Street in Anytown is a single family house there is a high probability that this is the same real world individual. But if you know that 123 Main Street in Anytown is a building used as a nursing home, a campus or that this entrance has many apartments or other kind of units, then it is not so certain that these records represents the same real world individual (not at least if the name is John Smith). So this example highlights the importance of using external reference data in data matching.”

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By the Infoglide Team

Boston Globe: 36 arrested in Medicare scams totaling $251M

“Violent criminals and mobsters are also tapping into the scams, seeing Medicare fraud as more lucrative than dealing drugs and having less severe criminal penalties, officials said. For instance, agents bugged a medical center in Brooklyn, N.Y., where eight people are charged with running a $72 million scam that submitted bogus claims for physical therapy for elderly Russian immigrants. Clinic owners paid patients, including undercover agents, in exchange for using their Medicare numbers and a bonus fee for recruiting new patients.”

ERIQ: ERIQ Director gives Entity Resolution Tutorial at MIT

“Interest in entity and identity resolution have been growing because they are key processes in the current movement to create information exchange hubs in health care, law enforcement, education, and the military…  He also announced that the ERIQ Research Center will launch an open-source entity resolution project called OYSTER to be available on Source Forge later this year.”

CBC News: Crime proceeds crackdown looms

“Someone can put many $20 bills from drug dealing into a casino slot machine, press the ‘cash out’ button on the machine and use the slip produced to get a cheque from the casino’s cashier. That produces a legitimate cheque without a direct transaction with a human being who might raise questions. FINTRAC expects casinos to combat this by noting the identity of anyone who receives a cashier’s cheque over $10,000, and reporting the transaction to the federal agency.”

Journal Gazette: Uniting the thin blue line

“‘Now there are 72 fusion centers around the nation, analyzing and disseminating data and information of all kinds. That is one for every state and others for large urban cities. It’s connecting the dots. That’s what the thing really is,’ said Sen. Tom Wyss, R-Fort Wayne, a state and national expert on the center.”

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By the Infoglide Team

Bloomberg: Banks Financing Mexico Gangs Admitted in Wells Fargo Deal

“Wachovia admitted it didn’t do enough to spot illicit funds in handling $378.4 billion for Mexican-currency-exchange houses from 2004 to 2007. That’s the largest violation of the Bank Secrecy Act, an anti-money-laundering law, in U.S. history — a sum equal to one-third of Mexico’s current gross domestic product.”

HIMSS: Informed Patient Identity Solution

“The identification of the patient is not always accurate in healthcare. Information for one individual may exist in one or multiple databases where it resides as ‘duplicate,’ inaccessible or unknown to those needing to see the complete or most current picture. Due to administrative errors, information on two different individuals can be ‘overlaid’ and presented as one person’s record. Linking the wrong clinical information to a person not only can cause great personal harm to the patient, but also can incur huge costs to the healthcare provider in correcting and mitigating the error.”

ExecutiveGov: Napolitano Announces Progress in 9/11 Commission Security Recommendations

“‘By working with our partners across the globe, we have achieved historic advances in international aviation security – including bolstering explosives detection, strengthening the vetting of passengers against terrorist watchlists, refining passenger screening techniques and deploying tens of thousands of trained aviation security personnel—that make air travel safer for everyone.’ Among other things, the report showed that aviation security received a large boost with the implementation of Secure Flight for 100 percent of passengers flying domestically and internationally on U.S. airlines.”

ERIQ: 15th Annual ICIQ Conference in Little Rock, AR, November 12-14, 2010

“The Donaghey College of Engineering and Information Technology at the University of Arkansas at Little Rock (UALR) will host the 15th International Conference on Information Quality  (ICIQ) on November 12-14, 2010.  The  ICIQ attracts researchers and practitioners in the academic, public and private sectors from across the globe.”

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[Post from Infoglide] 21st Annual ACFE Fraud Conference & Exhibition

“If you’re involved in fraud detection, then you’re probably aware of ACFE, the Association of Certified Fraud Examiners. With over 50,000 members, it’s the largest single fraud anti-fraud organization in the world. ACFE is also the publisher of FRAUD magazine. Starting Sunday, July 25 and continuing through Wednesday, July 28, the 21st Annual ACFE Fraud Conference & Exhibition will be held at the Gaylord National Resort and Convention Center in National Harbor, Maryland. If you’re attending, please come by and meet us at Infoglide Software Booth 329…”

Washington Examiner: Maryland recovers nearly $26.5 million in Medicaid fraud

“Brown said the False Health Claims Act, which goes into effect Oct. 1, will allow the state to recover even more dollars. Since 2006, the Department of Health and Mental Hygiene has identified or recovered more than $100 million in Medicaid fraud and waste, according to DHMH Inspector General Thomas V. Russell.”

Jeff Jonas: Hell with Rules

“Data triage systems, especially those that must detect ever-changing crafty adversaries, should be principle-based where possible; otherwise, you won’t be one step behind.  You will be at two or more steps behind… The notion that “principles outperform rules” probably applies to most, if not all, of the decisioning processes.”

Orange County Register: O.C. man fights state’s ‘fraud epidemic’

“Smith insists, ‘For every dollar they spend, they’d get $100 in income and sales tax revenue. The government doesn’t know how to find the companies that cheat ’so they just come hassle guys who comply with the law,’ Smith says. ‘They spend a lot of man hours and find little.’”

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By the Infoglide Team

CNSNews.com: New Regulations Outline Content, Transmission Standards for Every Americans’ Electronic Health Records

“The EHRs are designed to be digital replications of the hard-copy, paper health records commonly in use today. They are also engineered to be easily transferable among different doctors and hospitals so as to eliminate the creation of duplicate or disparate records among different health care providers, thus allowing any health care office to access a patient’s complete medical record at each visit.”

Washington Post: Firms slow to embrace cloud computing

“‘There’s an awful lot of talk about it and there is consumption of cloud,’ said Al Gillen, an analyst at IDC. But ‘organizations don’t simply make change because they can. There has to be good justification.’ Harry Weller, a general partner at New Enterprise Associates, said start-ups and new businesses will likely be among the first to move to the cloud. A need to hold down costs is often an overriding factor in their decision, he said.”

Detroit Free Press: Arrests made for Medicare fraud

“Many of the charges involved home health care companies that billed Medicare for equipment or treatment that many patients didn’t need or never received. In several cases, people who worked for the companies were paid to recruit patients to participate in the scheme. Some persuaded elderly people to sell their Medicare identification numbers, which were used to rip off the system.”

Liliendahl on Data Quality: Data Quality is an Ingredient, not an Entrée

“Fortunately it is more and more recognized that you don’t get success with Business Intelligence, Customer Relationship Management, Master Data Management, Service Oriented Architecture and many more disciplines without starting with improving your data quality. But it will be a big mistake to see Data Quality improvement as an entrée before the main course being BI, CRM, MDM, SOA or whatever is on the menu.”

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[Post from Infoglide] Exposing Fraudulent Networks in Healthcare

“More than half of the $98 million in ‘improper payments’ by the federal government in 2009 were made through Medicare and Medicaid. A recent article in the New England Journal of Medicine points out that ’since 1990, the Government Accountability Office (GAO) has designated Medicare as a high-risk federal program because its vast size and complexity make it vulnerable to fraud, waste, and abuse.’”

CapitalSoup.com: CFO Alex Sink Announces Joint Investigation Arrests In Mortgage Fraud Crackdown

“Investigators discovered that Alan Weitz, vice president of Bal Bay Properties, and his son Brandon Weitz, working for the same company, recruited ’straw buyers’ who were offered $3,000 each to allow their names to be used on mortgage loan applications to purchase homes with the understanding that the properties would be quit-claimed over to an actual buyer.”

KXAN.com: Homeland Security praises new fusion center

“The Fusion Center, seeded with Homeland Security money, collaborates the effort and information of local, state and federal authorities. Austin’s Fusion Center is yet to be fully operational, but last February it played a critical role in the rescues at the Echelon Building.”

News 6: 94 individuals charged in the largest Medicare fraud case in history

“The defendants participated in schemes to submit claims to Medicare for treatments that were unnecessary and in many times never provided. The defendants include doctors, health care company owners, executives and others, which collectively defrauded Medicare for approximately $251 million.”

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By Mike Betron, Infoglide Software Director of Marketing

More than half of the $98 million in “improper payments” by the federal government in 2009 were made through Medicare and Medicaid. A recent article in the New England Journal of Medicine points out that “since 1990, the Government Accountability Office (GAO) has designated Medicare as a high-risk federal program because its vast size and complexity make it vulnerable to fraud, waste, and abuse.” The article goes on to discuss how to combat the fraud through better screening.

“Increasingly, federal investigators have found that the Medicare system is being infiltrated by criminals and organized criminal networks.” One solution suggested is “imposition of more stringent entry requirements on the 18,000 applicants who, in an average month, seek Medicare’s approval to bill the program for service.” Every day, identity resolution software screens every airline passenger on every U.S. domestic flight to detect known criminals and terrorists. Could the same technology screen 18,000 new healthcare program applicants every month?

The article suggests that the Department of Health and Human Services (DHHS) be empowered “to determine which Medicare providers should create internal compliance programs designed to make them more vigilant against fraud.” Today, banks and insurance companies are using identity resolution software to detect the social networks of fraud rings. Could the same technology with its similarity searching and hidden identity detection form the core of a new system that screens internal activity to monitor compliance?

“Kimberly Brandt, director of the CMS’s program-integrity group, emphasized that the newly granted authority would enable the agency to move away from its historical ‘pay and chase’ mode to focus greater resources on fraud prevention.” Every day, identity resolution software screens every airline passenger on every U.S. domestic flight to prevent known criminals and terrorists from boarding airplanes without being detected. Could the same technology be used to make the whole Medicare and Medicaid infrastructure more proactive in preventing fraud?

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